Mrs. Reagan Faces Surgery in a Test for Breast Cancer

First Lady Nancy Reagan will undergo surgery today to determine whether a “suspicious lesion” in her left breast is cancerous, the White House announced Friday.

If the mass is malignant, officials said, physicians will immediately remove the breast and the lymph nodes from beneath her left armpit, a procedure known as a modified radical mastectomy.

“All other alternatives” of treatment “have been discussed with the First Lady, and she accepts the procedure recommended for her circumstance,” said White House spokesman Marlin Fitzwater, who did not explain why Mrs. Reagan opted for this surgery. Doctors say one reason that some women prefer this procedure is because it could avoid weeks of radiation treatment.

The lesion, which cannot be felt by physical examination, was discovered Oct. 5 during a routine mammogram, an X-ray of the soft tissue of the breast, Fitzwater said. The size of the lesion could not be determined, he said.

The 66-year-old First Lady, who earlier Friday traveled to a Foster Grandparents conference in Somersworth, N. H., entered Bethesda Naval Medical Center Friday night, accompanied by President Reagan and her brother, Dr. Richard Davis, of Philadelphia. Fitzwater said that the President planned to spend the night in the White House and return to the hospital early this morning, remaining at the hospital during the day.

Tells of ‘Great Confidence’

The President, responding to a question from a reporter during a photo session, said: “Well, of course I’m concerned, and so is she. But, at the same time, I have great confidence in the medical personnel who are in charge of this case.”

“I’m sure he’s worried,” said Elaine Crispen, Mrs. Reagan’s press secretary and longtime friend. “My God, they care so much about each other, how could you not worry? He worries when she goes away on an overnight trip. But they’re great disciplinarians and strong-willed.”

Fitzwater, who noted that the President “has been through some very serious operations himself,” said Mrs. Reagan was in “good spirits” and joked to her husband: “I guess it’s my turn.” The President underwent surgery for colon cancer in July, 1985, and has had four skin cancer lesions removed from his nose in the last two years. In December, 1982, Mrs. Reagan had a malignant skin cancer removed from above her lip.

The biopsy, which uses a needle to extract a sample of the suspected lesion to determine the precise location of the tumor, is scheduled to begin at 7:30 a.m., Fitzwater said, and physicians “should know within an hour or two whether or not they will continue.” He said that there are “no plans at this time” for reconstructive surgery of Mrs. Reagan’s breast.

If Mrs. Reagan undergoes a mastectomy, the additional surgery will probably take another one to two hours, and Mrs. Reagan would remain hospitalized from five days to a week, Fitzwater said. As part of the operation, physicians presumably would study the nodes to determine if the cancer has spread beyond the breast, a process known as “staging.”

Betty Ford Surgery Cited

If a mastectomy is performed, Mrs. Reagan would be the second First Lady to undergo such surgery. In September, 1974, surgeons removed the right breast of First Lady Betty Ford, wife of President Gerald R. Ford, after tests disclosed a malignant tumor. Several months later, Happy Rockefeller, wife of Vice President Nelson A. Rockefeller, underwent two separate cancer operations to remove both breasts. Both women survive.

The First Lady’s physicians include Dr. Oliver Beahrs and Dr. Donald McIlrath, of the Mayo Clinic, in Rochester, Minn.; Dr. John E. Hutton Jr., the President’s physician; and Capt. Harry B. Etienne, chief of general surgery at Bethesda. Last January, a team of seven physicians from the Mayo Clinic, assembled at the request of Mrs. Reagan, performed prostate surgery on the President.

Physicians said Friday that lesions such as Mrs. Reagan’s, if malignant, are usually early cancers that have rarely spread beyond the breast.

“If you’re going to pick up a cancer of the breast, it’s better to pick it up on a mammogram, rather than by a physical exam,” said Dr. Edward Soma, president of the radiology group at Holy Cross Hospital in Silver Spring, Md. “We can detect carcinomas up to two or three years before they become palpable.”

Survival Rate High

Women with early breast cancer have a 90% chance of surviving five years, at which time they are considered cured, according to the National Cancer Institute.

But some physicians said that Mrs. Reagan could have chosen less disfiguring surgery for such a cancer, which has an identical survival rate. Such a procedure typically involves the removal of only the lump--known as a lumpectomy--followed by radiation therapy. The lymph nodes are always removed and studied to be certain the tumor has not spread, doctors said.

“The patient does have an option, depending on the tumor’s size and location,” said Dr. Norman Isaacson, clinical professor of surgery at George Washington University Medical Center. “Not knowing the size or location of Mrs. Reagan’s tumor, I can’t comment on her decision. But if it’s less than two centimeters and located in the upper outer quadrant--closest to the armpit--it’s just as curable by lumpectomy and supplemental radiation.”

However, Isaacson said, some women opt for the more radical surgery “because they don’t want to go through five weeks of radiation.”

Mammograms are generally recommended every two years for women over age 40 and annually for women over 50.

Staff writer Betty Cuniberti contributed to this story.

TYPES OF SURGERY FOR BREAST CANCER

First Lady Nancy Reagan will have a biopsy today to determine whether a lump in her left breast is cancerous. If further surgery is warranted, doctors say they will perform a modified radical mastectomy--an operation in which the breast and nearby lymph nodes are removed. The operation is less severe than a radical mastectomy, but more extensive than other alternatives. Shaded areas show what is removed in each method. Cancer is shown by black spots. These are the other types of surgery:

1. Radical mastectomy--breast, lymph nodes, surrounding muscle removed.

2. Simple mastectomy--breast, nipple, skin removed, but not lymph nodes or muscle.

3. Subscutaneous mastectomy--breast removed, but not nipple or skin.

4. Lumpectomy or segmental mastectomy--removal of cancer and surrounding tissue.